Selective transvenous embolization of dural carotid—cavernous sinus fistulas with preservation of sylvian venous outflow

✓ A transvenous embolization technique in which normal cerebral venous drainage can be spared is described. Of 26 dural carotid—cavernous fistulas treated by the authors, the affected cavernous sinus received not only the shunted flow but also the sylvian venous drainage in three cases. Two patients presented with an abducent nerve palsy, and one with an oculomotor nerve palsy. Selective transvenous embolization of the fistulous portions of the affected cavernous sinus was achieved, with preservation of the sylvian venous outflow. Postembolization angiograms revealed complete occlusion of the fistula in one patient and only a small amount of residual shunt in the other two. One of these two underwent subsequent transarterial embolization, and the other was followed without additional treatment. The patients' symptoms resolved between 1 and 2 months posttreatment. Follow-up angiograms revealed that the remnant shunt had disappeared and the sylvian venous pathway had been preserved. The authors conclude that selective transvenous embolization of fistulous compartments in an affected sinus can be used to treat dural arteriovenous fistulas involving a cavernous sinus that also receives the sylvian venous outflow.

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Selective transvenous embolization of dural carotid-cavernous sinus fistulas with preservation of sylvian venous outflow

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.4.14 ◽

1998 ◽

Vol 5 (4) ◽

pp. E13

Author(s):

Mitsugu Nakamura ◽

Norihiko Tamaki ◽

Tetsuro Kawaguchi ◽

Shigekiyo Fujita

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Venous Drainage ◽

Additional Treatment ◽

The Other ◽

Oculomotor Nerve Palsy ◽

Transvenous Embolization ◽

Venous Outflow ◽

Abducent Nerve Palsy

A transvenous embolization technique that spares normal cerebral venous drainage is described. Of 26 dural carotid-cavernous fistulas treated by the authors, in three cases the affected cavernous sinus was supplied by not only the shunt flow but also the sylvian venous drainage. Two patients presented with an abducent nerve palsy and one with an oculomotor nerve palsy in whom selective transvenous embolization of the fistulous portions of the affected cavernous sinus was achieved while preserving of the sylvian venous outflow. Posttransvenous embolization angiograms showed complete occlusion of the fistula in one patient and only small residual shunts in the other two; one underwent subsequent transarterial embolization, whereas the other was followed without additional treatment. The patients' symptoms disappeared between 1 and 2 months posttreatment. Follow-up angiograms revealed that the remnant shunt had disappeared and that the sylvian venous pathway had been preserved. The authors conclude that although the condition is uncommon it is important to recognize that a dural carotid-cavernous sinus fistula, which receives significant sylvian venous outflow, can be treated successfully by selective transvenous embolization of the fistulous compartments in an affected sinus.

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Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula: association with the volume and location of detachable coils

Journal of Neurosurgery ◽

10.3171/jns/2008/109/8/0208 ◽

2008 ◽

Vol 109 (2) ◽

pp. 208-214 ◽

Cited By ~ 44

Author(s):

Kazuhiko Nishino ◽

Yasushi Ito ◽

Hitoshi Hasegawa ◽

Bumpei Kikuchi ◽

Junsuke Shimbo ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Dural Arteriovenous Fistula ◽

Oculomotor Nerve Palsy ◽

Transvenous Embolization ◽

Cumulative Volume ◽

Coil Volume

Object Transvenous embolization (TVE) for the treatment of a cavernous sinus (CS) dural arteriovenous fistula (DAVF) occasionally causes cranial nerve palsy (CNP). Overpacking of coils is considered to result in CNP. The purpose of this study was to analyze the association of TVE-induced CNP with the volume and location of coils activated in the CS. Methods Thirty-one patients with CS DAVFs (33 lesions) underwent TVE. Results Cranial nerve palsy occurred or was aggravated in 13 cases (39.4%; CNP group). The cumulative volume of activated coils was significantly greater in the CNP group (0.241 ± 0.172 cm3) than in the non-CNP group (0.119 ± 0.075 cm3; p < 0.05). Of those lesions with > 0.2 cm3 of coil volume, 77.8% showed immediate aggravation or a new occurrence of CNP after TVE. Five lesions treated with a smaller volume of coils showed a delayed worsening or occurrence of CNP. In cases with induced oculomotor nerve palsy, coils had been densely packed in the superolateral part of the anterior CS. Dense packing in the lateral portion of the posterior CS frequently induced abducent nerve palsy. Although patients harboring lesions with a greater coil volume required a longer recovery time, newly developed or aggravated CNP, related to 84.6% of the lesions, resolved completely. Conclusions The cumulative volume and specific locations of coils in the CS correlated with TVE-induced CNP. Overpacking appeared to be the predominant cause of CNP; however, for CNP in cases involving smaller coil volumes, an alternative mechanism may be involved.

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Pituitary Apoplexy Causing Compression of Third Cranial Nerve—Management

Indian Journal of Neurosurgery ◽

10.1055/s-0039-1694849 ◽

2019 ◽

Vol 08 (02) ◽

pp. 119-122

Author(s):

Václav Masopust

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Clinical Symptoms ◽

Rapid Development ◽

Sella Turcica ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Future Research ◽

Third Nerve Palsy ◽

Increased Pressure

AbstractLesions of the oculomotor nerve as the first sign of pituitary adenoma are rare. The cause of such lesions without other clinical symptoms is discussed in this study. A small cohort of 4 patients (3.1%) with oculomotor nerve palsy (third nerve palsy) as the only neurologic deficit, from 129 patients who got operated upon for pituitary adenomas, is presented. In this group (mean age: 55 years, range: 36–65 years), all patients (two women and two men) underwent surgery. In two cases, there was arrested pneumatization and thickened bone. In the remaining two cases, a macroscopically visible, very solid opaque diaphragm was present, after the removal of the tumor and thickened bone. Complete adjustment was observed in all patients within 1 week after the surgery. Two factors that seem to increase the high risk for the development of oculomotor nerve palsy are that the cavernous sinus may be the only weak structure surrounding the sella turcica when the diaphragm and bone are thickened; and the rapid development of increased pressure in this region. The increased pressure on the cavernous sinus during the anatomical variations is the primary cause for lesions on the oculomotor nerve. However, this conjecture cannot be statistically demonstrated because of the small number of cases. Future research should be conducted on larger samples to increase statistical inference and generalizability.

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Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/15910199970030s217 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 88-92

Author(s):

N. Kuwayama ◽

S. Endo ◽

M. Kubo ◽

T. Akai ◽

A. Takaku

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulas ◽

Type D ◽

Dural Arteriovenous Fistulas ◽

The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

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Surgical Treatment of Cavernous Sinus Cavernomas: Evidence from Vietnam

Reports ◽

10.3390/reports3020016 ◽

2020 ◽

Vol 3 (2) ◽

pp. 16

Author(s):

Duc-Anh Nguyen ◽

Hao The Nguyen ◽

Thang Van Duong ◽

Binh Hoa Pham ◽

Hoang-Long Vo

Keyword(s):

Magnetic Resonance Imaging ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Tumor Surgery ◽

Resonance Imaging ◽

Radical Removal

Cavernous sinus cavernomas, a rare vascular malformation, represents 3% of all benign cavernous sinus tumors. Both clinical and radiological signs are important for differentiating this condition from other cavernous sinus diseases. The best treatment is radical removal tumor surgery; however, due to the tumor being located in the cavernous sinus, there are many difficulties in the surgery. We report a case of a 35-year-old female who only presented sporadical headache. After serial magnetic resonance imaging acquisitions, a tumor measuring 30 mm in the left cavernous sinus and heterogenous enhencement was observed. Then, the patient underwent an operation with an extradural basal temporal approach. Postoperatively, the tumor was safely gross total removed. The patient developed left oculomotor nerve palsy but fully recovered after 3 months of acupunture treatment, and developed persistent left maxillofacial paresthesia. The surgical treatment for cavernous sinus cavernomas may be considered a best choice regarding safety and efficiency.

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Transvenous Embolization for Dural Arteriovenous Shunt of the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/159101990701300406 ◽

2007 ◽

Vol 13 (4) ◽

pp. 353-358 ◽

Cited By ~ 8

Author(s):

S. Kato ◽

H. Ishihara ◽

H. Nakayama ◽

M. Fujii ◽

H. Fujisawa ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Dural Arteriovenous Fistula ◽

Clinical Symptoms ◽

Transarterial Embolization ◽

Arteriovenous Shunt ◽

Complete Disappearance ◽

Transvenous Embolization ◽

Arteriovenous Shunts

We describe the treatment and follow-up clinical symptoms and angiographic results in patients with dural arteriovenous fistula of the cavernous sinus treated by transvenous embolization (TVE). We have treated eight cases of dural arteriovenous fistula of the cavernous sinus by multi-staged TVE in two cases and TVE with sinus packing in six and three of six cases were treated with a combination of transarterial embolization. Multi-staged TVE was performed by occlusion from dangerous drainage veins to the cavernous sinus on several occasions. Angiographical results showed disappearance or reduction of the arteriovenous shunt in all cases. Six patients presented with ophthalmic symptoms and two had tinnitus. Six cases had complete disappearance of clinical symptoms after treatment. There was a deterioration of ocular movement in one patient treated by TVE with sinus packing. Multi-staged TVE was performed to reduce the coil volume for the packing of the cavernous sinus in two cases without cranial nerve palsy. Embolization, especially multi-staged TVE, was considered a good treatment to occlude arteriovenous shunts at the cavernous sinus without cranial nerve complications.

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A possible mechanism of isolated oculomotor nerve palsy by apoplexy of pituitary adenoma without cavernous sinus invasion: a report of two cases

Acta Neurochirurgica ◽

10.1007/s00701-011-1165-4 ◽

2011 ◽

Vol 153 (12) ◽

pp. 2453-2456 ◽

Cited By ~ 14

Author(s):

Hiroyuki Kobayashi ◽

Masahito Kawabori ◽

Shunsuke Terasaka ◽

Junichi Murata ◽

Kiyohiro Houkin

Keyword(s):

Pituitary Adenoma ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Cavernous Sinus Invasion

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Cavernous sinus dural arteriovenous fistula accessed through a straightened superficial temporal vein

Surgical Neurology International ◽

10.25259/sni_1035_2021 ◽

2021 ◽

Vol 12 ◽

pp. 634

Author(s):

Teishiki Shibata ◽

Yusuke Nishikawa ◽

Takumi Kitamura ◽

Mitsuhito Mase

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Chronic Total Occlusion ◽

Nerve Palsy ◽

Dural Arteriovenous Fistula ◽

Abducens Nerve ◽

Transvenous Embolization ◽

Access Route ◽

Treatment Procedure ◽

Total Occlusion

Background: Transvenous embolization through the inferior petrosal sinus (IPS) is the most common treatment procedure for cavernous sinus dural arteriovenous fistula (CSDAVF). When the IPS is inaccessible or the CSDAVF cannot be treated with transvenous embolization through the IPS, the superficial temporal vein (STV) is used as an alternative access route. However, the approach through the STV is often challenging because of its tortuous and abruptly angulated course. We report a case of recurrent CSDAVF which was successfully treated using a chronic total occlusion (CTO)-dedicated guidewire and by straightening the STV. Case Description: A 63-year-old woman was diagnosed with CSDAVF on examination for oculomotor and abducens nerve palsy. She was initially treated with transvenous embolization through the IPS. However, CSDAVF recurred, and transvenous embolization was performed through the STV. A microcatheter could not be navigated because of the highly meandering access route through the STV. By inserting a CTO-dedicated guidewire into the microcatheter, the STV was straightened and the microcatheter could be navigated into a shunted pouch of the CS. Finally, complete occlusion of the CSDAVF was achieved. Conclusion: If an access route is highly meandering, the approach can be facilitated by straightening the access route with a CTO-dedicated guidewire.

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